| NPI | 1285202317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13472) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 0010-13472) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2025-03-12 |